The First Care of the Injured was the title of an interesting paper by Dr. A. H. Meisenback, of St. Louis, in which the first aid to the injured was pointed out as of paramount importance. He said large cities should provide special appliances for the police, fire, and health departments for use in all cases of emergency until a surgeon could be called, and that members of the departments should receive instructions as to how they should give the first necessary aid to the injured. Railway trains should be equipped with appliances for binding and stanching of wounds, and railway surgeons should be required to give lectures or simple illustrations to brakemen and conductors as to how to act in cases of accident. There were thousands of cases where a little knowledge would be of inestimable value. Wounds should be protected from all kinds of foreign substances and proper action taken for bandaging as soon as possible after injury.

Dr. W. V. Lucas, of Mendon, read a paper on Pneumonia. He attributed his success in the treatment of this disease to the early use of quinine.

Dr. Frank R. Fry, of St. Louis, read a paper on Paramyoclonus Multiplex. It related to the spasmodic action of the muscles of the limbs, especially of the lower extremities. The case of a young woman who suffered from these spasms, and the fact that she had worked a sewing machine for twelve years, was developed.

The last paper of the evening was upon Diseases of the Lymphatics and Absorbents as a Cause of Anemia, by Dr. O. B. Campbell, of St. Joseph. Remedies were suggested for the treatment of the disease.

The Association then adjourned to the Centropolis Hotel, where a sumptuous banquet was given the visiting members by the local society. The various toasts were responded to by able

men in the legal, pharmaceutical, and medical professions. "The Pulpit" called out Rev. Dr. J. C. Morris, who made some excellent hits at the faith-cure and Christian scientists. "The Medical Profession" brought Dr. I. N. Love, of St. Louis, to his feet. For its efforts in solidifying the work of the profession, in extending the investigations of the few to the many, it is entitled to great honor and respect. The medical journal of America should be the pride of the sixty thousand earnest workers who surround it, and to whom it carries the tidings of the outer world.

THIRD DAY'S SESSION.

After preliminary business, the third and last day's session of the Missouri State Medical Association was opened by the reading of an interesting paper by Dr. A. B. Shaw, of St. Louis, entitled, A Case Presenting Unique Symptoms, the Result of Disease of the Nervous System due to Railroad Accidents.

A paper upon Leprosy told of a case within the personal experience of Dr. A. H. Ohman Dumesnil, of St. Louis, the first case reported in Missouri.

The paper by Dr. William Porter, of St. Louis, was referred without reading.

The Committee on State Medicine made its report on the subject of an experimental and vaccine laboratory, and recommended that the Association foster the plan of the State University. Also that the legislature be requested to appropriate sufficient funds at its next meeting to carry out the work in a thorough manner, to enable it to supply vaccine free to all public institutions, all educational institutions and health officers, and at a minimum cost to the profession.

A paper on Nervous Pathology was read by Dr. B. F. Wilson, of Salsbury.

Dr. J. W. Heddens, of St. Joseph, substituted a paper on Hernia instead of one giving statistics of the State Insane Asylum.

An election of officers was held, with the following result: President, Dr. A. M. McAlester, of Columbia; Vice-Presidents, J. D, Griffith, of Kansas City, J. H. Britts, of Clinton, W. A. Camp, of Springfield, H. C. Dalton of St. Louis, and J. B. Winn, of Macon; Sec

retaries, J. C. Mulhall, of St. Louis, and J. H. Duncan, of Kansas City; Recording Secretary, L. I. Matthews, of Kansas City; Treasurer, C. A. Thompson, of Jefferson City.

The Objectivity of Sense Perception, by Dr. S. S. Laws, President of the State University, was read by title and referred to the Committee on Publication.

Some Points in the Management of Typhoid Fever was the topic discussed by Dr. I. N. Love, of St. Louis. He recommended cooling baths of tepid water as a valuable aid in treatment, followed by thorough rubbing and a little broth. He thought quinine should be ruled out altogether, or if given used very cautiously. Typho-malaria was considered a misnomer, the disease being nothing less than typhoid fever with malaria. Typhoid fever varied in severity in different cases; management rather than medication was the necessity in treatment, with nutritive liquids and tranquil rest.

The Nervous System in Disease was one of a series of papers which Dr. C. H. Hughes, of St. Louis, said he hoped to be able to prepare for future meetings. He discussed the effect of nervous diseases on the blood, using the case of the late Hon. A. H. Stephens, of Georgia, as an illustration.

Dr. G. Hurt, of St. Louis, read a portion of his paper upon the Laws and Appropriations of other States and of the United States in the Interest of Public Health.

The hour for adjournment having arrived, the president elect, Dr. McAlester, was escorted to the chair, where he was introduced by the retiring president, Dr. Lutz. After the customary resolution of thanks for the hospitality shown by Kansas City, the convention adjourned to meet in Springfield next year. The attendance on the Association was two hundred and sixty-nine, the largest number ever enrolled.

BRONCHITIS IN ELDERLY PATIENTS.-Dr. Woodbury considers twenty-minim doses of dilute phosphoric acid, along with elixir of cinchona, of good service in bronchitis of elderly people. If there is much cough, give also syrup of wild cherry.-Medical Times.

Translations.

SEAT OF THE GONOCOCCI.-(Orcel, Lyon Médic. 4, ix, 1887; Viertelj. f. Syph. und Derm., 1888-2.) The gonococcus is found not only in the pus but also in the tissue. If, after the patient has urinated or injected, we scrape the urethral mucous membrane with a small horn or ivory curette pushed some distance into the urethra, we easily obtain the proof of this. In order therefore to protect the posterior urethra only small quantities of liquids should be injected, and then with slight force. The patient should urinate before injecting, because it washes out the urethra, and as a consequence the mucous membrane is more readily influenced by the medication employed, and permits of a longer contact.

In the slides prepared from the curette Orcel never saw the gonococci in the cells, but always free, either alone or in groups.

LIGATURE OF THE THYROID ARTERIES TO PRODUCE ATROPHY OF GOITRE.-(Prof. Billroth, Weiner Klinische Wochenschrift, April, 1888.) The writer states that the brilliant operation of extirpation of the thyroid gland in goitre has of late years caused dissatisfaction, because (1) we can not prevent tetanus, which occasionally follows the operation; (2) because, even with the greatest care, the recurrent laryngeal nerve is often either cut through or included in the ligature; and (3) because, after thyroid extirpation in children, the well-known cachexia strumpriva not infrequently occurs.

Woelfler re-introduced the operation of tying the four arteries, and inasmuch as atrophy can only take place in living and well-nourished tissue, the operation is not completely successful where the struma contains portions of cystic and calcareous degenerations, or where the tissue is almost necrobiotic.

The indications for this operation being plain, Billroth writes of the effect thus:

1. The first effect of the ligature of the four arteries is to produce glandular ane-. mia, since these goitres are very vascular;

2. The second effect is seen in the nourishment of the tumor; the slight collateral circulation is not enough to keep alive the cells in the struma. The vessels are obliterated, epithelial and connective tissue disappear, and only cicatricial tissue remains.

It is probable that the cachexia which often follows in children is avoided because atrophy occurs gradually in the course of weeks or months. The atrophy (as shown by experience) is permanent.

In ulcerated wounds, with little or no tendency to heal, antipyrine, one part to three of vaseline, applied on cotton, has been found of excellent service. The ulcerated surfaces, even in cases of mammary carci noma, remain fresh and healthy much longer than with chloride of zinc, and the dressing need be renewed but twice a week; so that

CHOREA AGRIA CURED WITH ANTIPYRINE. (Boussi, La France Medicale; Deutsche Med. Zeit., April 5, 1888.) Boussi treated a child aged eight, with severe chorea following a scarlatinous arthritis, with antipyrine, and secured a complete cure in a very short time. Decided improvement was manifest after four doses of fifty centigrams (seven and a half grains) given in one day. After thirty-two such doses (that is, half an ounce) had been taken in eight days, only occasional involuntary movements were noticed, and these disappeared entirely when three grams (forty-five grains) more had been taken.

ON THE HEMOSTATIC EFFECT OF ANTIPYRINE. (Wien Med. Wochen., April 14, 1888.) At the meeting of the Biological Society, at Paris, on January 7th, Henoque spoke as follows: The peculiarities of each case determine the method of administration. In one case it should be given as a powder, in a second in solution, in a third as a salve. When used as a powder it can be applied directly to the wounded surface, and over it a pledget of cotton or charpie can be applied. In epistaxis it is best used by insufflation, in metrorrhagia it should be applied on cotton to the cervix or uterine cavity. When parenchymatous bleeding is to be stopped, a solution of 1 to 20 is the best; if, however, the hemorrhage comes from concealed or deeper seated places, it is well to be

but also as a deodorant and antiseptic.

SURGICAL TREATMENT IN TUBERCULOSIS OF THE BLADDER.-Guyon, of Paris, found in two such cases localized tuberculosis of the bladder accessible to the surgical measures.

CASE 1-a twenty-year-old patient with very painful tubercular cystitis not affecting the genital apparatus. Guyon performed sectio alta, enlarged the neck of the bladder and covered all diseased portions with iodoform oil. After seventeen days' drainage the patient recovered completely, and has remained well for three years.

CASE 2. Patient forty years old, has localized tuberculosis of the bladder. Bladder opened again by supra-pubic operation, the diseased portions curetted and cauterized with ferrum candens. The tuberculosis got got well, but the cystitis remained; the bacilli disappeared from the urine. The writer thinks that we should interfere surgically even in those cases where tuberculosis has attacked the genital apparatus, if constitutional treatment has been ineffectual. He prefers the supra-pubic operation to all others.

Abstracts and Selections.

ON SUBSTITUTION IN DISEASE, ESPECIALLY OF THE NERVOUS SYSTEM.-The principle of substitution has a wide range of applica tion in the human body. It is manifested as a physiological condition in a state of health. Thus the skin in summer exhales at least much more moisture than in the cold of winter, and the quantity of urine secreted by the kidneys is proportionately diminished, while in winter the reverse holds true the skin is less active and the amount of urinary secretion is increased. There are many forms of disease, besides those that are the more immediate subject of this paper, in which this substitutionary action is evident. Vicarious menstruation is a good illustration. Some years ago a patient was under my care on account of a large ulcer of the leg and amenorrhea, with marked anemia. About every four weeks there was a sanguineous oozing from the ulcer, and this had been going on for many months. There could be no doubt that the menstrual flux had taken this irregular channel of exit. Cases have also occurred in my experience in which the lungs or stomach were apparently discharging, though imperfectly and usually in excess, this function of the uterus. It must, how ever, be admitted that not many cases of this kind have come under my notice. Some, which on first impression seemed to be of this nature, on further observation resolved themselves into local disease of these organs, attended by hemorrhage at intervals resembling those of the menses, ordinary menstruation being in abeyance.

In chronic Bright's disease other emunctory organs often undertake to some extent the special renal function of excreting the nitrogenous waste of the system. I have met with cases in which daily vomiting gave much relief. The last one was that of a boy, aged fifteen, in the Royal Infirmary, who suffered from the inflammatory form of the disease in its second stage. The vomiting occurred without impairment of appetite or other evidence of gastric derangement. On beginning his meal, or even before he partook of it at all, he would sometimes vomit freely, and in a few minutes, when he had rested a little, he would finish the meal with a relish. The vomited matter was twice tested for urea, but none was found. Still it was probable that, if not urea, other elements of the urine were being excreted by the stomach.

In view of the physiological relationship between the skin and the kidneys, to which reference has already been made, it is perhaps somewhat surprising that there should not be a very obvious compensatory action of the former in Bright's disease. There does indeed appear to be an effort on the part of the excretory apparatus of the skin to eliminate waste constituents in the blood which the kidneys have failed to remove, and in uremia this is sometimes a marked feature. But though this be so, the rule is to find the skin harsh and dry, and unperspiring, its functions diminished rather than increased.

But

Misplaced or irregular gout is a good illustration of this substitutionary action, particularly when it is retrocedent from the joints, and affects one or other of the internal organs, such as the stomach. the course of procedure may be the reverse of this, as is illustrated by a case which came under my observation not long since. A lady of middle age was for years subject to severe gastralgia, with neuralgic pains in the back of the neck, and latterly had two rather serious attacks of bilious diarrhea. Gout is hereditary in the family to which she belongs, but she herself had never suffered from it in the regular articular form, and was hoping she would escape it alto gether, particularly as she had been most careful both in eating and drinking. Still, she had been suffering as described. At last there was an outburst of articular inflammation, particularly of the joints of the hands, with immediate and complete relief to all her internal troubles.

Rheumatism may interchange with mental disease. A few years since a female patient was admitted under my care into the City Asylum, in an attack of acute mania. She had up to the time of her insanity suffered from a prolonged illness of a rheumatic kind, many of her larger joints being affected. While her mental illness lasted-a period of some weeks--the articular trouble disappeared, but on its subsidence the rheumatic disorder once more made its appear

ance.

The healing of old ulcers is attended with great risk in certain constitutions. I recall the following cases, which occurred in the course of my experience: A laboring man, about seventy years of age, had long suffered from a large ulcer of his leg. It was successfully treated, the discharge gradually diminished, and the sore cicatrized to a point. He was then seized with sanguineous apoplexy, and died within forty-eight

hours. Another patient, about sixty years old, was likewise under treatment for an ulcer of the leg of a large size, which had been open for a number of years. Treatment was successful in the healing of the sore; but while he was congratulating himself on getting rid of a trouble which interfered materially with his comfort and also with his capacity for work, he had a severe epileptic fit-a disease with which he had never previously been afflicted. A third case was that of an elderly man who, whenever the ulcer on his leg arrived at a certain stage of the healing process-had diminished to about a fourth of its ordinary sizebegan to suffer from a violent headache. He was told that it would be unsafe to allow the sore to cicatrize any further, and that if he wanted it closed entirely it would be requisite, in the first instance, to put a seton in his neck. He wisely chose to rest contented with his ulcer in its reduced size.

In this connection I mention an incident that happened in my own person. Some twenty years ago, while suffering from general derangement of the system, with an outbreak of boils, inflammation began in the terminal phalanx of one of my fingers, which had all the characters of a developing whitlow. Poulticing and other such measures gave no relief, so with gruesome apprehension I purposed consulting one of my surgical friends, anticipating that an incision to the bone would be required. However, I determined that I would myself first cut down through the thickened epidermis. This I accordingly did, and exposed the raw, hypersensitive true skin. Afterward I tried to raise the epidermis at the bottom of the incision, but failed. Within an hour or two the superficial swelling increased, and a burning, benumbing sensation was felt in it; at the same time the throbbing, rending sensation at the bone quickly subsided. The superficial inflam. mation continued severe for a day or two, and then passed away without suppuration, but for two or three months afterward the integument remained thickened and almost devoid of feeling. The impression that I have regarding this experience is, that on making the incision through the cuticle the morbid action in my finger left the periosteum and its neighborhood, and concentrated in the exposed and highly irritable cutis vera.

It is, however, in diseases of the nervous system, inclusive of the brain, that we see the clearest and most striking illustrations of the action of the principle under consid

eration. It is almost the rule rather than the exception in many of the hereditary neuroses, to find that the particular form of disease which exists in the son or daughter is not that which was present in the parent or grandparent from whom it has been derived, but one different in its character though allied in nature-there is transmutation in the descent. Thus it is common for an epileptic parent to have a child with some defect in his nervous system other than epilepsy-it may be a variety of mental disease, such as mania, or the insane temperament, or mere imbecility or idiocy; or, conversely, a father subject to maniacal attacks begets a child who becomes epileptic. It is, however, not for a moment denied, on the contrary it is fully admitted, that epilepsy may be inherited as such from the parent. I have myself met with striking instances of this fact. Habits of drunkenness induce a morbid state of the brain, spinal cord, and nerves. Children procreated after the change in the nutrition of the nervous system has been established by prolonged habits of intoxication may, no doubt, inherit an oinomania or drink craving, which shows itself when they reach manhood or womanhood; but the insane temperament is probably more common as the expression of the inherited defect, or even some form of fullydeveloped insanity, but possibly it may be only hysteria, or other milder variety of nervous disorder.

The

Spasmodic asthma may be the outcome of the inherited vice of constitution, which was of a very different character in the parent. In the early part of last year a case of this kind was under my care in the Infirmary. The patient was a woman about twenty-four years of age. She had been asthmatic for twelve months, and supposed her troubles to have been due to a cold she got at the beginning of her illness, but examination of the chest in the intervals of the paroxysms revealed only a slight emphysema. seizures occurred at first about once a month, but latterly they had become more frequent, and their duration was longer, lasting for two or three days in a severe form. struation was regular. The family history showed that the patient's mother had been long insane, and an inmate of a lunatic asylum. But, further, the girl herself was under the necessity of leaving the Infirmary one morning quite unexpectedly, owing to a message she got that her maternal aunt had become deranged in mind. The fact that both the mother and aunt, they being sisters, were insane, indicates that in all

Men